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Child Mortality Report 2011

Child Mortality Report 2011

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Published by UNICEF
Only four years remain to achieve Millennium
Development Goal 4 (MDG 4), which calls for
reducing the under-five mortality rate by twothirds
between 1990 and 2015. Since 1990 the
under-five mortality rate has dropped 35 percent,
with every developing region seeing at least a 30
percent reduction. However, at the global level
progress is behind schedule, and the target is at
risk of being missed by 2015. The global underfive mortality rate needs to be halved from 57 deaths per 1,000 live births to 29—that implies an average rate of reduction of 13.5 percent a year, much higher than the 2.2 percent a year achieved between 1990 and 2010.

Child mortality is a key indicator not only of child
health and nutrition but also of the implementation of child survival interventions and, more broadly, of social and economic development. As global momentum and investment for accelerating child survival grow, monitoring progress at the global and country levels has become even more critical. The United Nations Inter-agency Group for Child Mortality Estimation (IGME) updates child mortality estimates annually for
monitoring progress. This report presents the
IGME’s latest estimates of under-five, infant and
neonatal mortality and assesses progress towards MDG 4 at the country, regional and global levels.
Only four years remain to achieve Millennium
Development Goal 4 (MDG 4), which calls for
reducing the under-five mortality rate by twothirds
between 1990 and 2015. Since 1990 the
under-five mortality rate has dropped 35 percent,
with every developing region seeing at least a 30
percent reduction. However, at the global level
progress is behind schedule, and the target is at
risk of being missed by 2015. The global underfive mortality rate needs to be halved from 57 deaths per 1,000 live births to 29—that implies an average rate of reduction of 13.5 percent a year, much higher than the 2.2 percent a year achieved between 1990 and 2010.

Child mortality is a key indicator not only of child
health and nutrition but also of the implementation of child survival interventions and, more broadly, of social and economic development. As global momentum and investment for accelerating child survival grow, monitoring progress at the global and country levels has become even more critical. The United Nations Inter-agency Group for Child Mortality Estimation (IGME) updates child mortality estimates annually for
monitoring progress. This report presents the
IGME’s latest estimates of under-five, infant and
neonatal mortality and assesses progress towards MDG 4 at the country, regional and global levels.

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Levels & Trends in

Child Mortality

Report 2011
Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation

United Nations DESA/Population Division

This report was prepared at UNICEF Headquarters by Danzhen You, Gareth Jones and Tessa Wardlaw on behalf of the United Nations Inter‑agency Group for Child Mortality Estimation. Organizations and individuals involved in generating country-specific estimates on child mortality United Nations Children’s Fund Danzhen You, Tessa Wardlaw World Health Organization Ties Boerma, Colin Mathers, Mie Inoue, Mikkel Oestergaard The World Bank Emi Suzuki United Nations Population Division Francois Pelletier, Gerhard Heilig, Kirill Andreev, Patrick Gerland, Danan Gu, Nan Li, Cheryl Sawyer, Thomas Spoorenberg United Nations Economic Commission for Latin America and the Caribbean Population Division Dirk Jaspers Faijer, Guiomar Bay, Tim Miller Special thanks to the Technical Advisory Group of the Inter-agency Group for Child Mortality Estimation for providing technical guidance on methods for child mortality estimation Kenneth Hill (Chair), Harvard University Leontine Alkema, National University of Singapore Simon Cousens, London School of Hygiene and Tropical Medicine Trevor Croft, Measure DHS, ICF Macro Gareth Jones, Consultant Michel Guillot, University of Pennsylvania Jon Pedersen, Fafo Neff Walker, Johns Hopkins University John Wilmoth, University of California, Berkeley

Further thanks go to Priscilla Akwara, Mickey Chopra, Archana Dwivedi, Jimmy Kolker, Richard Morgan, Holly Newby and Ian Pett from UNICEF for their support as well as to Joy Lawn from Save the Children for her comments. And special thanks to Mengjia Liang from UNICEF for her assistance in preparing the report. Communications Development Incorporated provided overall design direction, editing and layout. Copyright © 2011 by the United Nations Children’s Fund The Inter‑agency Group for Child Mortality Estimation (IGME) constitutes representatives of the United Nations Children’s Fund, the World Health Organization, the World Bank and the United Nations Population Division. The child mortality esti‑ mates presented in this report have been reviewed by IGME members. As new information becomes available, estimates will be updated by the IGME. Differences between the estimates presented in this report and those in forthcoming publications by IGME members may arise because of differences in reporting periods or in the availability of data during the production process of each publication and other evidence. While every effort has been made to maximize the comparability of statistics across countries and over time, users are advised that country data may differ in terms of data collection methods, population coverage and estimation methods used. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of UNICEF, the World Health Organization, the World Bank or the United Nations Population Division concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its fron‑ tiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. On 9 July 2011 the Republic of South Sudan seceded from the Republic of the Sudan and was subsequently admitted to the United Nations on 14 July 2011; disaggregated data for Sudan and South Sudan as separate states are not yet available. Data and maps in this report refer to Sudan as it was constituted in 2010. United Nations Children’s Fund 3 UN Plaza, New York, New York, 10017 USA The World Bank 1818 H Street, NW, Washington, DC, 20433 USA World Health Organization Avenue Appia 20, 1211 Geneva 27, Switzerland United Nations Population Division 2 UN Plaza, New York, New York, 10017 USA

PROGRESS TOWARDS MillEnniuM DEvElOPMEnT GOAl 4: KEY FACTS AnD FiGuRES
• Overall, substantial progress has been made towards achieving MDG 4. The number of under-five deaths worldwide has declined from more than 12 million in 1990 to 7.6 million in 2010. Nearly 21,000 children under five died every day in 2010—about 12,000 fewer a day than in 1990. • Since 1990 the global under-five mortality rate has dropped 35 percent—from 88 deaths per 1,000 live births in 1990 to 57 in 2010. Northern Africa, Eastern Asia, Latin America and the Caribbean, South-eastern Asia, Western Asia and the developed regions have reduced their nder-five mortality rate by 50 peru cent or more. • The rate of decline in under-five mortality has accelerated—from 1.9 percent a year over 1990–2000 to 2.5 percent a year over 2000–2010—but remains insufficient to reach MDG 4, particularly in SubSaharan Africa, Oceania, Caucasus and Central Asia, and Southern Asia. • The highest rates of child mortality are still in Sub-Saharan Africa—where 1 in 8 children dies before age 5, more than 17 times the average for developed regions (1 in 143)—and Southern Asia (1 in 15). As under-five mortality rates have fallen more sharply elsewhere, the disparity between these two regions and the rest of the world has grown. • Under-five deaths are increasingly concentrated in Sub-Saharan Africa and Southern Asia, while the share of the rest of the world dropped from 31 percent in 1990 to 18 percent in 2010. • In Sub-Saharan Africa the average annual rate of reduction in under-five mortality has accelerated, doubling from 1990– 2000 to 2000–2010. Six of the fourteen best-performing countries are in Sub-Saharan Africa, as are four of the five countries with the largest absolute reductions (more than 100 deaths per 1,000 live births). • About half of under-five deaths occur in only five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan and China. India (22 percent) and Nigeria (11 percent) together account for a third of all under-five deaths. • Over 70 percent of under-five deaths occur within the first year of life. • The proportion of under-five deaths that occur within the first month of life (the neonatal period) has increased about 10 percent since 1990 to more than 40 percent. • Almost 30 percent of neonatal deaths occur in India. Sub-Saharan Africa has the highest risk of death in the first month of life and has shown the least progress. • Globally, the four major killers of children under age 5 are pneumonia (18 percent), diarrhoeal diseases (15 percent), preterm birth complications (12 percent) and birth asphyxia (9 percent). Undernutrition is an underlying cause in more than a third of under-five deaths. Malaria is still a major killer in Sub-Saharan Africa, causing about 16 percent of under-five deaths.

1

Introduction
Only four years remain to achieve Millennium Development Goal 4 (MDG 4), which calls for reducing the under-five mortality rate by twothirds between 1990 and 2015. Since 1990 the under-five mortality rate has dropped 35 percent, with every developing region seeing at least a 30 percent reduction. However, at the global level progress is behind schedule, and the target is at risk of being missed by 2015. The global underfive mortality rate needs to be halved from 57 deaths per 1,000 live births to 29—that implies an average rate of reduction of 13.5 percent a year, much higher than the 2.2 percent a year achieved between 1990 and 2010. Child mortality is a key indicator not only of child health and nutrition but also of the implementation of child survival interventions and, more broadly, of social and economic development. As global momentum and investment for accelerating child survival grow, monitoring progress at the global and country levels has become even more critical. The United Nations Inter-agency Group for Child Mortality Estimation (IGME) updates child mortality estimates annually for monitoring progress. This report presents the IGME’s latest estimates of under-five, infant and neonatal mortality and assesses progress towards MDG 4 at the country, regional and global levels.

2

The UN Inter-agency Group for Child Mortality Estimation The IGME was formed in 2004 to share data on child mortality, harmonize estimates within the UN system, improve methods for child mortality estimation, report on progress towards the Millennium Development Goals and enhance country capacity to produce timely and properly assessed estimates of child mortality. The IGME, led by the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO), also includes the World Bank and the United Nations Population Division of the Department of Economic and Social Affairs as full members.
The IGME’s independent Technical Advisory Group, comprising leading academic scholars and independent experts in demography and biostatistics, provides guidance on estimation methods, technical issues and strategies for data analysis and data quality assessment. Generating accurate estimates of child mortality poses a considerable challenge because of the limited availability of high-quality data for many developing countries. Complete vital registration systems are the preferred source of data on child mortality because they collect information as events occur and they cover the entire population. However, many developing countries lack fully functioning vital registration systems that accurately record all births and deaths. Therefore, household surveys, such as the UNICEFsupported Multiple Indicator Cluster Surveys and the US Agency for International Development– supported Demographic and Health Surveys, are the primary sources of data on child mortality in developing countries. The IGME seeks to compile all available nationallevel data on child mortality, including data from vital registration systems, population censuses, household surveys and sample registration systems. To estimate the under-five mortality trend series for each country, a statistical model is fitted to data points that meet quality standards established by the IGME and then used to predict a trend line that is extrapolated to a common reference year, set at 2010 for the estimates in this report. To predict infant mortality rates, model life tables are used to transform under-five mortality rates. To predict neonatal mortality rates, a

statistical model is used to transform under-five mortality rates.

Changes to data sources and methodology The IGME updates its child mortality estimates annually after reviewing newly available data and assessing data quality. In preparing the estimates in this report, the IGME recalculated direct estimates from all available Demographic and Health Surveys for calendar year periods, using single calendar years for reference periods shortly before the survey and then gradually increasing the number of years for reference periods further in the past. For a given survey the cut-off points for shifting from estimates for single calendar years to two years, or two years to three and so on are based on the coefficients of variation (a measure of sampling uncertainty) of the estimates. The Technical Advisory Group suggested this recalculation because the sample sizes of many household surveys have grown in recent years, allowing for shorter reference periods. The recalculated direct estimates with shorter reference periods replace the five-year periods used in previous estimations, thereby increasing the number of data points for more recent years.
In addition, a substantial amount of newly available data has been incorporated: data from the most recent surveys and censuses for about 30 countries, new data from vital registration systems for more than 50 countries and data from more than 70 surveys and censuses conducted before 2000 for about 20 countries. The increased data availability has resulted in substantial changes in the estimates for some countries from previous years. Because the fitted under-five mortality rate trend line is based on the entire time series of data available for each country and because model life tables and a statistical model are used to derive estimates of infant and neonatal mortality rates based on under-five mortality rates, the estimates presented in this report may differ from and not be comparable with previous sets of IGME estimates and the most recent underlying country data. Furthermore, this year the IGME used a different curve-fitting methodology. More details on the data and methods used in deriving the estimates are available in the IGME’s child mortality database, CME Info (www.childmortality.org).
3

Support for data collection at country level Modelled estimates of child mortality can only be as good as the underlying data. The IGME members, including UNICEF, the WHO and other UN agencies, are actively involved at the country level in strengthening national capacity in data collection, estimation techniques and interpretation of results.
Population-based survey data are critical for developing sound estimates for countries lacking functioning vital registration systems. The UNICEF-supported Multiple Indicator Cluster Surveys programme has been working since 1995 to build country-level capacity for survey implementation, data analysis and dissemination. The surveys are government owned and implemented, and UNICEF provides financial and technical support through workshops, technical consultations and peer-to-peer mentoring. More than 230 surveys have been conducted in more than 100 countries. In addition to population-based surveys, the WHO and the UN Statistics Division work with countries to strengthen vital registration systems. UNICEF supports this work by promoting birth registration and monitoring its progress. The United Nations Population Fund provides technical assistance for population censuses, another important source of child mortality data. The IGME strengthens capacity by working with countries to improve understanding of child

mortality data and estimation. CME Info (www. childmortality.org ), a comprehensive data portal on child mortality funded by UNICEF and launched by the IGME, is a powerful platform for sharing underlying data and collaborating with national partners on child mortality estimates. Since 2008 a series of regional workshops has been held, training more than 250 participants from 94 countries in the use of CME Info as well as the demographic techniques and modelling methods underlying the estimates. In the last three years UNICEF and the IGME have sent experts to about 10 countries to conduct training on child mortality estimation. As part of the data review process, UNICEF’s network of field offices provides opportunities to assess the plausibility of estimates by engaging in a dialogue about the estimates and the underlying data. WHO also engages its Member States in a country consultation process through which governments provide feedback on the estimates and their underlying data. Guiding this capacity strengthening work is a fundamental principle: child mortality estimation is not simply an academic exercise but a fundamental part of effective policies and programming. UNICEF works with countries to ensure that child mortality estimates are used effectively at the country level, in conjunction with other data on child health, to improve child survival programmes and stimulate action through advocacy. This work involves partnering with other agencies, organizations, and initiatives such as the Countdown to 2015.

4

Levels and Trends in Child Mortality, 1990–2010
Under-five mortality The latest estimates of under-five mortality from the UN Inter-agency Group for Child Mortality estimation (IGME) show a 35 percent decline in the under-five mortality rate globally, from 88 deaths per 1,000 live births in 1990 to 57 in 2010 (table 1 and figure 1). Over the same period, the total number of under-five deaths in the world has declined from more than 12 million in 1990 to 7.6 million in 2010 (table 2).
Five of nine developing regions show reductions in under-five mortality of more than 50 percent over 1990–2010 (figure 2). Northern Africa has achieved MDG 4, with a 67 percent reduction, and Eastern Asia is close, with a 63 percent reduction. Sub-Saharan Africa and Oceania have achieved only around a 30 percent reduction in under-five mortality, less than half that required to reach MDG 4. However, Sub-Saharan Africa—also combating the HIV/AIDS pandemic that has affected countries in the region more than elsewhere in the world—has doubled its average rate of reduction from 1.2 percent a year over 1990–2000 to 2.4 percent a year over 2000–2010. A major reason for the limited progress in reducing child mortality at the global level, despite more than half the regions having already achieved reductions of more than 50 percent, is the large and growing share of under-five deaths that occur in Sub-Saharan Africa and Southern Asia (82 percent; figures 3 and 4). Of the 26 countries with under-five mortality rates above 100 deaths per 1,000 live births in 2010, 24 are in SubSaharan Africa (map 1). Thus, to achieve MDG 4, substantial progress is needed in both regions. Fourteen of sixty-six countries with at least 40 under-five deaths per 1,000 live births in 2010 reduced their under-five mortality rate by at least half between 1990 and 2010 (figure 5). TimorLeste, Bangladesh, Nepal, the Lao People’s Democratic Republic, Madagascar and Bhutan recorded declines of at least 60 percent, or more than 4.5 percent a year on average. In absolute terms the greatest reductions were in Niger, Malawi, Liberia, Timor-Leste and Sierra Leone (surpassing 100 deaths per 1,000 live births during the period). That 9 of the 14 countries are from Sub-Saharan Africa and Southern Asia, the two regions most in need of a faster reduction of the under-five mortality rate, shows that substantial progress can be made in these regions. Among developed regions under-five mortality rates exceeded 10 deaths per 1,000 live births in 2010 in the Republic of Moldova, Albania, Romania, Ukraine, Bulgaria, Russian Federation and The former Yugoslav Republic of Macedonia. Some 70 percent of the world’s under-five deaths in 2010 occurred in only 15 countries, and about half in only five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan and China (figure 6). India (22 percent) and Nigeria (11 percent) together account for a third of underfive deaths worldwide. Overall, substantial progress has been made towards achieving MDG 4. About 12,000 fewer children died every day in 2010 than in 1990, the baseline year for measuring progress. Improvement in child survival is evident in all regions. The number of countries with under-five mortality rates of 100 deaths per 1,000 live births or higher has been halved from 52 in 1990 to 26 in 2010. In addition, no country had an under-five mortality rate above 200 deaths per 1,000 live births in 2010, compared with 13 countries in 1990. The rate of decline has accelerated from 1.9 percent a year over 1990–2000 to 2.5 percent a year over 2000–2010. Moreover, in Sub-Saharan Africa, the region with the greatest burden of under-five deaths, the rate of decline doubled. But these rates are still insufficient to achieve MDG 4 by 2015: only 6 of 10 regions are on track to achieve the MDG 4.
5

TAblE

1

levels and trends in the under-five mortality rate, by Millennium Development Goal region, 1990–2010 (deaths per 1,000 live births)
Average annual rate of reduction (percent) 1990–2010 Progress towards Millennium Development Goal 4 target 2010

Region

1990

1995

2000

2005

2009

2010

MDG target 2015

Decline (percent) 1990–2010

Developed regions Developing regions Northern Africa Sub-Saharan Africa Latin America and the Caribbean Caucasus and Central Asia Eastern Asia Excluding China Southern Asia Excluding India South-eastern Asia Western Asia Oceania World

15 97 82 174 54 77 48 28 117 123 71 67 75 88

11 90 62 168 44 71 42 36 102 107 58 57 68 82

10 80 47 154 35 62 33 30 87 91 48 45 63 73

8 71 35 138 27 53 25 19 75 80 39 38 57 65

7 64 28 124 22 47 19 18 67 73 34 33 53 58

7 63 27 121 23 45 18 17 66 72 32 32 52 57

5 32 27 58 18 26 16 9 39 41 24 22 25 29

53 35 67 30 57 42 63 39 44 41 55 52 31 35

3.8 2.2 5.6 1.8 4.3 2.7 4.9 2.5 2.9 2.7 4.0 3.7 1.8 2.2

On track Insufficient progress On track Insufficient progress On track Insufficient progress On track On track Insufficient progress Insufficient progress On track On track Insufficient progress Insufficient progress

a “On track” indicates that under-five mortality is less than 40 deaths per 1,000 live births in 2010 or that the average annual rate of reduction is at least 4 percent over 1990–2010; “insufficient progress” indicates that under-five mortality is at least 40 deaths per 1,000 live births in 2010 and that the average annual rate of reduction is at least 1 percent but less than 4 percent over 1990–2010. These standards may differ from those in other publications by Inter-agency Group for Child Mortality Estimation members.

TAblE

2

levels and trends in the number of deaths of children under age five, by Millennium Development Goal region, 1990–2010 (thousands)
Share of global under-five deaths (percent) 2010

Region

1990

1995

2000

2005

2009

2010

Decline (percent) 1990–2010

Developed regions Developing regions Northern Africa Sub-Saharan Africa Latin America and the Caribbean Caucasus and Central Asia Eastern Asia Excluding China Southern Asia Excluding India South-eastern Asia Western Asia Oceania World

227 11,782 304 3,734 623 155 1,308 29 4,521 1,443 853 270 14 12,010

151 10,550 210 3,977 511 119 845 46 3,930 1,233 696 247 15 10,702

129 9,446 153 4,006 397 86 704 30 3,354 1,060 530 201 15 9,575

112 8,355 121 3,956 305 80 423 16 2,829 875 453 173 14 8,467

102 7,654 100 3,752 237 79 349 17 2,588 837 368 167 14 7,756

99 7,515 95 3,709 249 78 331 17 2,526 830 349 165 14 7,614

56 36 69 1 60 50 75 41 44 42 59 39 0 37

1.3 98.7 1.2 48.7 3.3 1.0 4.3 0.2 33.2 10.9 4.6 2.2 0.2 100.0

6

FiGuRE

1

under-five mortality declined in all regions between 1990 and 2010

FiGuRE

2

Under-five mortality rate, by Millennium Development Goal region, 1990 and 2010 (deaths per 1,000 live births) 200
174

Many regions have reduced the under-five mortality rate by at least 50 percent between 1990 and 2010

Decline in under-five mortality rate, by Millennium Development Goal region, 1990–2010 (percent) 75
67 63 57 121

150
117

55

50
97 82 88 42

52

100
75 77 71

44

35

53 31

66

67

63

52

54

50

45

48

57

25
32 32 27 23 18 15

Sub-Saharan Africa

South-eastern Asia

Western Asia

Northern Africa

Southern Asia

Caucasus and Central Asia

Latin America and the Caribbean

Eastern Asia

Oceania

Developed regions

Developing regions

World

0

7

Northern Africa

South-eastern Asia

Western Asia

Sub-Saharan Africa

Eastern Asia

Latin America and the Caribbean

Southern Asia

Caucasus and Central Asia

Oceania

Developing regions

1990

2010

FiGuRE

3

in 2010, 7.6 million children died before their fifth birthday

FiGuRE

4

The global burden of under-five deaths is increasingly concentrated in Sub-Saharan Africa

Number of under-five deaths, by Millennium Development Goal region, 2010 (thousands) Developed regions 99 Western Asia 165 Latin America and the Caribbean 249 Eastern Asia 331 South-eastern Asia 349

Northern Africa 95 Caucasus and Central Asia 78 Oceania 14

Share of under-five deaths, by Millennium Development Goal region, 1990–2010 (percent) Developed regions Northern Africa Western Asia Caucasus and Central Asia Oceania 100 Latin America and the Caribbean Eastern Asia 80 South-eastern Asia

60 Southern Asia Sub-Saharan Africa 3,709 Southern Asia 2,526 20 Sub-Saharan Africa

40

0

1990

1995

2000

2005

Developed regions

World 2010

0

30

35

7

MAP

1

Children in Southern Asia and Sub-Saharan Africa face a higher risk of dying before their fifth birthday

Under-five mortality rate (deaths per 1,000 live births) Less than 40 40–99 100–149 150 or more Data not available

Note: Data for Sudan refer to the country as it was constituted in 2010, before South Sudan seceded on 9 July 2011.

FiGuRE

5

Of the 66 countries with high under-five mortality, 14 have seen reductions of at least 50 percent between 1990 and 2010

FiGuRE

6

Half of under-five deaths occur in just five countries

Number of under-five deaths, by country, 2010 (thousands)

Decline in under-five mortality rate, 1990–2010 (percent) 75
67 66 65

58

57

India 1,696
55 55 54

63

61

60

59

50

Other countries 2,958 Nigeria 861

25 Dem. Rep. of the Congo 465 Pakistan 423 China 315 Ethiopia 271

51

51

Uganda 141 Sudana 143 Lao People’s Democratic Republic Madagascar Timor-Leste Bangladesh Nepal Bhutan Malawi Cambodia Eritrea Bolivia Liberia Niger United Republic of Tanzania Azerbaijan 0 Indonesia 151 Afghanistan 191

a. Data refer to Sudan as it was constituted in 2010, before South Sudan seceded on 9 July 2011.

8

As under-five mortality rates have fallen more sharply in richer developing regions, the disparity between Sub-Saharan Africa and other regions has grown. In 1990 a child born in Sub-Saharan Africa faced a probability of dying before age 5 that was 1.5 times higher than in Southern Asia, 3.2 times higher than in Latin America and the Caribbean, 3.6 times higher than in Eastern Asia and 11.6 times higher than in developed regions. By 2010 that probability was 1.8 times higher than in Southern Asia, 5.3 times higher than in Latin America and the Caribbean, 6.7 times higher than in Eastern Asia and 17.3 times higher than in developed regions. The disparity between Southern Asia and richer regions has also grown, though not as much. Of the 66 countries with at least 40 deaths per 1,000 live births in 2010, only 11 are on track to achieve MDG 4 (map 2). But substantial advances have been made, particularly in Sub-Saharan Africa. Six of the fourteen best-performing countries are in Sub-Saharan Africa (see figure 5), as are four of the five countries with the largest absolute reductions in under-five mortality. Thus, there is increasing evidence that MDG 4 can be achieved, but only if countries in Sub-Saharan
MAP

Africa and Southern Asia give high priority to reducing child mortality, particularly by targeting the major killers of children (including pneumonia, diarrhoea, malaria and undernutrition) with effective preventative and curative interventions.
Neonatal mortality

Neonatal mortality, covering deaths in the first month after birth, is of interest because the health interventions needed to address the major causes of neonatal deaths generally differ from those needed to address other under-five deaths. Neonatal mortality is increasingly important because the proportion of under-five deaths that occur during the neonatal period is increasing as under-five mortality declines. Over the last two decades almost all regions have seen slower declines in neonatal mortality than in under-five mortality. Globally, neonatal mortality has declined 28 percent from 32 deaths per 1,000 live births in 1990 to 23 in 2010—an average of 1.7 percent a year, much slower than for under-five mortality (2.2 percent per year) and for maternal mortality (2.3 percent per year). The fastest reduction was in Northern Africa (55 percent), followed by Eastern Asia and Latin America and the Caribbean (52 percent); the

2

Many countries were on track in 2010 to achieve Millennium Development Goal 4, but progress needs to accelerate in several regions, particularly in Southern Asia and Sub-Saharan Africa

On track: under-five mortality is less than 40 deaths per 1,000 live births in 2010 or the average annual rate of reduction of under-five mortality is at least 4 percent over 1990–2010. Insufficient progress: under-five mortality is at least 40 deaths per 1,000 live births in 2010 and the average annual rate of reduction is at least 1 percent but less than 4 percent over 1990–2010.

No progress: under-five mortality is at least 40 deaths per 1,000 live births in 2010 and the average annual rate of reduction is less than 1 percent over 1990–2010. Data not available.

Note: These standards may differ from those in other publications by Inter-agency Group for Child Mortality Estimation members. Data for Sudan refer to the country as it was constituted in 2010, before South Sudan seceded on 9 July 2011.

9

slowest reduction was in Oceania and Sub-Saharan Africa (19 percent; table 3). Over the same period the share of neonatal deaths among under-five deaths has increased from about 37 percent to slightly above 40 percent worldwide and is expected to further increase as under-five mortality declines. While the relative increase is modest (9 percent) at the global level, there are differences across regions. The largest increases have been in Northern Africa (37 percent) and Eastern Asia (27 percent), the smallest in Oceania (7 percent; see table 3). In Eastern Asia, which had one of the largest declines in under-five mortality, neonatal deaths accounted for 57 percent of under-five deaths in 2010. Eastern Asia, Northern Africa and other richer developing regions will have to pay more attention to health interventions that address neonatal mortality in order to continue their success in reducing under-five mortality. Southern Asia also needs to address neonatal mortality: neonatal deaths account for 50 percent of under-five deaths, and almost 30 percent of global neonatal deaths occurred in India. Sub-Saharan Africa, which accounts for more than a third of global neonatal deaths, has the highest neonatal mortality rate (35 deaths per
TAblE

1,000 live births in 2010) and has shown the least progress in reducing that rate over the last two decades. With the proportion of under-five deaths during the neonatal period increasing in every region and almost all countries, systematic action is required by governments and partners to reach women and babies with effective care. Highly cost-effective interventions are feasible even at the community level, and most can be linked with preventive and curative interventions for mothers and for babies. For example, early postnatal home visits are effective in promoting healthy behaviours such as breastfeeding and clean cord care as well as in reaching new mothers. Case management of neonatal infections can be provided alongside treatment of childhood pneumonia, diarrhoea and malaria. Care at birth brings a triple return on investment, preventing stillbirths and saving mothers and newborns.

Disparity in child mortality Despite substantial progress in reducing underfive deaths, children from rural and poorer households remain disproportionately affected. Analyses based on data from household surveys for a subset of countries indicate that children in rural areas are about 1.7 times as likely to die

3

neonatal mortality rate, number of neonatal deaths and neonatal deaths as a share of under-five deaths, by Millennium Development Goal region, 1990 and 2010
Neonatal mortality rate (deaths per 1,000 live births) Decline (percent) 1990–2010 Number of neonatal deaths Neonatal deaths as a share of under-five deaths (thousands) (percent) Relative increase (percent) 1990–2010

Region

1990

2010

1990

2010

1990

2010

Developed regions Developing regions Northern Africa Sub-Saharan Africa Latin America and the Caribbean Caucasus and Central Asia Eastern Asia Excluding China Southern Asia Excluding India South-eastern Asia Western Asia Oceania World

7 36 29 43 23 30 23 12 48 48 28 28 26 32

4 25 13 35 11 21 11 9 32 33 15 16 21 23

43 31 55 19 52 30 52 25 33 31 46 43 19 28

106 4,319 107 969 265 58 589 14 1,875 576 335 116 5 4,425

53 3,019 46 1,123 117 34 189 8 1,256 381 169 79 5 3,072

47 37 35 26 42 37 45 47 41 40 39 43 37 37

53 40 49 30 47 44 57 48 50 46 48 48 40 40

15 10 37 17 11 18 27 1 20 15 23 12 7 9

10

before their fifth birthday as those in urban areas and that children from the poorest 20 percent of households are nearly twice as likely to die before their fifth birthday as children in the richest 20 percent of households (figure 7). Similarly, mother’s education remains a powerful determinant of inequity. Children of educated mothers—even mothers with only primary education—are more likely to survive than children of mothers with no education (see figure 7). Accelerating the decline in under-five mortality is possible by expanding interventions that target the main causes of deaths and the most vulnerable newborn babies and children. Empowering women, removing financial and social barriers to accessing basic services, developing innovations that make the supply of critical services more available to the poor and increasing local accountability of health systems are examples of policy interventions that have allowed health systems to improve equity and reduce mortality. An equity-focused approach could bring vastly improved returns on investment by averting far more child deaths and episodes of undernutrition and by markedly expanding effective coverage of key primary health and nutrition interventions.

FiGuRE

7

Children who live in poorer households and rural areas and whose mothers have less education are at higher risk of dying before age 5

Under-five mortality rate, by wealth quintile, residence and mother’s education, 2000–2010 (deaths per 1,000 live births) 150
146 121 114 101 114 90 62 67 91

120

90

30

Poorest

Second

Fourth

Richest

Middle

Urban

Wealth

Residence

Mother’s education

Note: Calculation is based on 39 countries with most recent Demographic and Health Surveys conducted after 2005, with further analyses by UNICEF for under-five mortality rates by wealth quintile, 45 countries for rates by residence and 40 countries for rates by mother’s education. The average was calculated based on under-five mortality rates weighted by number of births. Country-specific estimates obtained from Demographic and Health Surveys refer to a 10-year period prior to the survey. Because levels or trends may have changed since then, caution should be used in interpreting these results.

Secondary or higher

Rural

None

Primary

0

51

60

11

StatiStical table

country, regional and global estimates of under-five, infant and neonatal mortality
Number of under-five deaths (thousands) Infant mortality rate (deaths per 1,000 live births) Number of infant deaths (thousands) Neonatal mortality rate (deaths per 1,000 live births) Number of neonatal deaths (thousands)

Under-five mortality rate (deaths per 1,000 live births) Millennium Development Average annual Goal rate of reduction target for (percent) 2010 2015 1990–2010 149 18 36 4 161 8 14 20 5 4 46 16 10 48 20 6 4 17 115 56 54 8 48 19 7 13 176 142 51 136 6 36 159 173 9 18 19 86 93 9 10 123 6 6 70 14 23 3 81 9 9 18 3 3 31 7 6 48 6 6 3 15 59 46 40 6 20 20 4 7 68 61 40 46 3 20 55 69 6 16 12 42 39 7 6 50 4 4 1.7 4.1 3.2 4.1 2.1 5.9 3.3 5.1 2.9 4.1 3.5 1.6 2.7 5.5 –0.5 5.2 4.6 4.8 2.2 4.5 4.0 4.3 1.0 5.7 2.7 2.6 0.8 1.3 4.3 0.0 1.4 2.5 0.2 0.9 3.7 4.9 3.3 1.9 1.1 4.0 2.7 1.0 3.9 3.9

Country or territory Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba

1990 209 41 68 9 243 26 27 55 9 9 93 22 17 143 18 17 10 44 178 139 121 19 59 59 12 22 205 183 121 137 8 59 165 207 19 48 37 125 116 20 17 151 13 13

1990 128 3 53 0 123 0 20 4 2 1 19 0 0 527 0 3 1 0 37 3 28 1 3 210 0 3 85 45 38 66 3 1 19 55 6 1,279 33 2 10 0 1 76 1 3

2010 191 1 26 0 121 0 10 1 1 0 9 0 0 140 0 1 1 0 39 1 14 0 2 55 0 1 120 38 16 93 2 0 23 80 2 315 18 2 13 0 1 80 0 1

1990 140 36 55 7 144 23 24 46 8 8 74 18 15 99 16 14 9 35 107 96 84 17 46 50 9 18 103 110 87 85 7 46 110 113 16 38 30 88 74 17 15 105 11 11

2010 103 16 31 3 98 7 12 18 4 4 39 14 9 38 17 4 4 14 73 44 42 8 36 17 6 11 93 88 43 84 5 29 106 99 8 16 17 63 61 8 9 86 5 5

1990 87 3 43 0 74 0 18 4 2 1 15 0 0 363 0 2 1 0 23 2 20 1 2 174 0 2 43 27 24 42 3 1 13 30 5 1,025 27 1 7 0 1 53 1 2

2010 133 1 22 0 72 0 9 1 1 0 8 0 0 109 0 0 0 0 25 1 10 0 2 48 0 1 64 24 14 58 2 0 16 46 2 272 15 2 8 0 1 56 0 0

1990 53 17 29 3 51 13 15 26 5 4 31 9 6 55 9 7 4 18 40 45 39 12 22 28 7 11 41 49 38 34 4 21 43 45 9 24 20 40 33 9 10 46 8 7

2010 45 9 18 1 41 4 7 11 3 2 19 7 4 27 10 3 2 8 32 26 23 5 19 12 4 7 38 42 22 34 4 14 42 41 5 11 12 32 29 5 6 41 3 3

1990 40 1 23 0 28 0 11 2 1 0 6 0 0 208 0 1 1 0 9 1 9 1 1 102 0 1 18 12 16 17 2 0 5 13 3 576 19 1 3 0 1 24 0 1

2010 62 0 13 0 33 0 5 1 1 0 4 0 0 83 0 0 0 0 11 0 6 0 1 36 0 0 27 12 7 24 1 0 7 20 1 181 11 1 4 0 0 27 0 0

12

StatiStical table (ContInuED)

country, regional and global estimates of under-five, infant and neonatal mortality
Number of under-five deaths (thousands) Infant mortality rate (deaths per 1,000 live births) Number of infant deaths (thousands) Neonatal mortality rate (deaths per 1,000 live births) Number of neonatal deaths (thousands)

Under-five mortality rate (deaths per 1,000 live births) Millennium Development Average annual Goal rate of reduction target for (percent) 2010 2015 1990–2010 4 4 33 170 4 91 12 27 20 22 16 121 61 5 106 17 3 4 74 98 22 4 74 4 11 32 130 150 30 165 — 24 6 2 63 35 26 39 4 5 4 24 4 5 15 60 3 41 6 21 17 31 21 63 47 7 61 10 2 3 31 55 16 3 41 4 7 26 76 70 22 50 — 19 6 2 38 28 22 15 3 4 3 13 5.1 6.3 1.6 0.3 4.1 1.5 1.7 4.2 4.8 7.3 6.8 2.3 4.2 7.2 2.8 2.8 4.2 4.1 1.1 2.6 3.8 4.1 2.5 5.9 3.2 4.5 2.8 1.7 3.9 –0.4 — 4.4 5.8 5.5 3.0 4.4 4.6 0.8 4.1 4.4 4.6 2.3

Country or territory Cyprus Czech Republic Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Holy See Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica

1990 11 14 45 181 9 123 17 62 52 94 62 190 141 21 184 30 7 9 93 165 47 9 122 13 21 78 229 210 66 151 — 58 19 6 115 85 65 46 9 12 10 38

1990 0 2 16 312 1 3 0 13 15 174 10 3 18 1 398 1 0 6 3 7 4 7 68 1 0 26 58 9 1 38 — 11 3 0 3,078 403 122 30 0 1 5 2

2010 0 0 12 465 0 2 0 6 6 41 2 3 11 0 271 0 0 3 3 6 1 3 57 1 0 14 48 8 0 45 — 5 1 0 1,696 151 34 43 0 1 2 1

1990 10 12 23 117 7 95 14 48 41 68 48 118 87 17 111 25 6 7 68 78 40 7 77 11 17 56 135 125 50 104 — 45 17 5 81 56 50 37 8 10 8 31

2010 3 3 26 112 3 73 11 22 18 19 14 81 42 4 68 15 2 3 54 57 20 3 50 3 9 25 81 92 25 70 — 20 5 2 48 27 22 31 3 4 3 20

1990 0 2 7 206 0 2 0 10 12 126 8 2 12 0 245 0 0 5 2 3 4 6 43 1 0 19 35 5 1 26 — 8 2 0 2,185 261 92 24 0 1 5 2

2010 0 0 9 306 0 2 0 5 5 35 2 2 8 0 171 0 0 3 2 4 1 2 38 0 0 11 31 5 0 19 — 4 1 0 1,305 115 29 35 0 1 2 1

1990 5 9 22 48 4 40 11 29 20 28 18 45 31 13 48 12 4 3 31 42 27 4 38 9 10 28 51 48 34 38 — 23 12 3 47 31 28 23 5 6 6 13

2010 2 2 18 46 2 34 8 15 10 9 6 35 18 3 35 8 2 2 26 31 15 2 28 2 5 15 38 40 19 27 — 12 4 1 32 17 14 20 2 2 2 9

1990 0 1 9 89 0 1 0 6 6 50 3 1 4 0 112 0 0 3 1 2 2 3 22 1 0 10 14 2 1 10 — 4 2 0 1,299 149 51 16 0 1 3 1

2010 0 0 6 132 0 1 0 3 3 18 1 1 3 0 92 0 0 2 1 2 1 2 22 0 0 7 15 2 0 7 — 2 0 0 875 73 18 23 0 0 1 0

13

StatiStical table (ContInuED)

country, regional and global estimates of under-five, infant and neonatal mortality
Number of under-five deaths (thousands) Infant mortality rate (deaths per 1,000 live births) Number of infant deaths (thousands) Neonatal mortality rate (deaths per 1,000 live births) Number of neonatal deaths (thousands)

Under-five mortality rate (deaths per 1,000 live births) Millennium Development Average annual Goal rate of reduction target for (percent) 2010 2015 1990–2010 3 22 33 85 49 11 38 54 10 22 85 103 17 2 7 3 62 92 6 15 178 6 26 111 15 17 42 4 32 8 36 135 66 40 40 50 4 6 27 143 143 22 3 2 13 19 33 29 5 24 48 7 13 30 76 15 3 6 3 53 74 6 34 85 4 17 41 8 16 19 3 36 6 29 73 37 24 13 47 3 4 23 104 71 5 3 3.5 2.7 2.7 0.8 2.9 1.6 3.2 4.9 3.7 2.7 0.2 4.0 4.9 8.0 4.4 4.9 4.7 4.4 5.5 9.6 1.8 3.0 3.4 0.6 2.4 5.3 1.4 4.1 6.0 4.1 4.4 2.4 2.6 3.0 0.0 5.2 3.5 3.0 4.6 3.9 2.0 –2.3 5.5

Country or territory Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway

1990 6 38 57 99 87 15 72 145 21 38 89 227 45 10 17 8 159 222 18 102 255 11 51 124 24 49 56 9 107 18 86 219 112 73 40 141 8 11 68 311 213 14 9

1990 8 5 23 97 0 1 10 24 1 3 5 21 5 0 1 0 78 92 9 1 102 0 0 10 1 115 0 0 8 0 61 123 120 4 0 99 2 1 10 124 872 0 0

2010 3 4 13 122 0 1 5 8 0 2 5 15 2 0 0 0 44 56 3 0 120 0 0 13 0 37 0 0 2 0 23 114 56 2 0 35 1 0 4 100 861 0 0

1990 5 32 48 64 64 13 59 100 16 31 72 151 33 9 14 7 97 131 15 74 131 10 40 80 21 38 44 7 76 16 67 146 79 49 32 97 7 9 52 132 126 12 7

2010 2 18 29 55 39 10 33 42 8 19 65 74 13 2 5 2 43 58 5 14 99 5 22 75 13 14 34 3 26 7 30 92 50 29 32 41 4 5 23 73 88 19 3

1990 5 4 19 63 0 1 8 17 1 2 4 14 3 0 1 0 50 55 8 1 52 0 0 6 1 91 0 0 6 0 46 81 85 3 0 69 1 1 7 53 516 0 0

2010 3 3 11 80 0 1 5 6 0 1 4 11 2 0 0 0 31 36 3 0 68 0 0 9 0 31 0 0 2 0 20 77 43 2 0 29 1 0 3 52 537 0 0

1990 3 20 26 31 29 9 30 39 12 18 36 53 22 — 10 4 40 44 9 37 57 7 19 42 16 17 22 5 27 11 36 51 44 25 22 54 5 4 25 48 49 7 4

2010 1 13 17 28 19 6 19 21 5 12 35 34 10 — 3 1 22 27 3 9 48 4 12 39 9 7 18 2 12 5 19 39 32 17 22 28 3 3 12 32 40 10 2

1990 3 3 10 30 0 0 4 7 0 1 2 5 2 — 1 0 20 19 5 0 24 0 0 3 0 41 0 0 2 0 26 31 47 1 0 40 1 0 4 21 211 0 0

2010 1 2 6 43 0 0 2 3 0 1 2 5 1 — 0 0 16 18 2 0 34 0 0 5 0 16 0 0 1 0 12 35 26 1 0 20 1 0 2 24 254 0 0

14

StatiStical table (ContInuED)

country, regional and global estimates of under-five, infant and neonatal mortality
Number of under-five deaths (thousands) Infant mortality rate (deaths per 1,000 live births) Number of infant deaths (thousands) Neonatal mortality rate (deaths per 1,000 live births) Number of neonatal deaths (thousands)

Under-five mortality rate (deaths per 1,000 live births) Millennium Development Average annual Goal rate of reduction target for (percent) 2010 2015 1990–2010 22 9 87 19 20 61 25 19 29 6 4 8 5 19 14 12 91 8 16 21 20 2 80 18 75 7 14 174 3 8 3 27 180 57 5 17 103 31 78 3 5 16 63 13 15 16 41 11 11 30 17 26 20 6 5 7 3 12 12 9 54 9 8 9 9 4 31 15 46 10 6 92 3 6 3 15 60 20 4 11 42 17 32 2 3 13 39 11 3.6 8.3 1.8 2.8 2.5 1.9 3.5 7.1 3.6 5.2 6.6 4.8 2.4 3.3 4.9 4.1 2.9 6.3 1.8 1.3 1.5 9.0 0.8 4.6 3.1 7.1 1.0 2.3 4.9 4.1 6.0 2.6 0.0 0.3 3.9 3.2 1.0 2.6 1.0 4.2 2.4 4.3 3.1 4.5

Country or territory Occupied Palestinian Territory Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudana Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand

1990 45 47 124 33 33 90 50 78 59 17 15 21 8 37 37 27 163 28 23 27 12 94 45 139 29 17 276 8 18 10 45 180 60 11 32 125 52 96 7 8 38 116 32

1990 4 3 551 0 2 12 7 50 120 9 2 0 4 3 15 60 52 0 0 0 0 0 0 25 42 4 0 45 0 1 0 1 52 64 4 11 126 0 4 1 1 17 25 35

2010 3 1 423 0 1 12 4 11 66 3 0 0 3 1 3 20 38 0 0 0 0 0 0 12 34 1 0 39 0 0 0 0 70 58 2 6 143 0 3 0 0 8 12 11

1990 36 36 96 27 26 65 40 55 42 15 11 17 6 30 29 22 99 22 18 21 23 11 61 36 70 25 14 162 6 15 9 36 108 47 9 26 78 44 70 6 7 31 91 26

2010 20 8 70 15 17 47 21 15 23 5 3 7 4 16 11 9 59 7 14 19 17 2 53 15 50 6 12 114 2 7 2 23 108 41 4 14 66 27 55 2 4 14 52 11

1990 3 3 431 0 2 9 5 36 85 8 1 0 4 3 12 48 32 0 0 0 0 0 0 19 21 3 0 26 0 1 0 0 33 50 4 9 80 0 3 1 0 14 20 29

2010 3 0 347 0 1 10 3 9 52 2 0 0 2 1 3 16 25 0 0 0 0 0 0 10 23 1 0 26 0 0 0 0 42 41 2 5 92 0 2 0 0 7 10 9

1990 — 22 51 14 14 30 24 27 23 11 7 10 3 15 15 12 41 17 13 16 10 5 28 20 40 16 9 57 4 12 5 18 52 18 6 18 39 21 24 3 4 18 37 17

2010 — 5 41 9 9 23 14 9 14 4 2 4 2 9 8 6 29 5 10 13 8 1 25 10 27 4 8 45 1 4 2 12 52 18 3 10 35 14 21 2 3 9 25 8

1990 — 2 230 0 1 4 3 18 46 6 1 0 2 1 5 25 12 0 0 0 0 0 0 12 13 2 0 10 0 1 0 0 15 20 3 6 43 0 1 0 0 8 8 18

2010 — 0 194 0 1 5 2 6 32 1 0 0 1 0 2 10 13 0 0 0 0 0 0 6 13 0 0 10 0 0 0 0 21 19 1 4 50 0 1 0 0 4 5 7

Saint Vincent and the Grenadines 27

15

StatiStical table (ContInuED)

country, regional and global estimates of under-five, infant and neonatal mortality
Number of under-five deaths (thousands) Infant mortality rate (deaths per 1,000 live births) Number of infant deaths (thousands) Neonatal mortality rate (deaths per 1,000 live births) Number of neonatal deaths (thousands)

Under-five mortality rate (deaths per 1,000 live births) Millennium Development Average annual Goal rate of reduction target for (percent) 2010 2015 1990–2010 12 55 103 16 27 16 18 56 33 99 13 7 5 76 8 11 52 14 18 23 77 111 80 13 56 49 8 12 16 27 33 19 58 7 7 3 52 4 8 26 13 11 17 43 61 26 5.9 5.6 1.8 2.2 1.6 5.6 7.5 2.8 2.7 2.8 2.4 5.7 2.9 3.6 1.6 3.7 2.0 5.1 3.0 4.0 2.5 2.5 –0.1

Country or territory The former Yugoslav Republic of Macedonia Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe

1990 39 169 147 25 37 49 80 98 57 175 21 22 9 155 11 23 77 39 33 51 128 183 78

1990 1 4 22 0 1 11 107 13 0 143 15 1 7 166 44 1 56 0 19 99 75 60 29

2010 0 2 19 0 1 3 24 6 0 141 7 1 4 133 32 1 31 0 11 34 69 60 29

1990 34 127 87 21 32 39 66 78 44 106 18 18 8 95 9 20 63 31 28 37 90 109 52

2010 10 46 66 13 24 14 14 47 27 63 11 6 5 50 7 9 44 12 16 19 57 69 51

1990 1 3 13 0 1 9 87 11 0 88 13 1 6 103 37 1 46 0 16 70 52 36 19

2010 0 2 12 0 0 3 19 5 0 92 6 1 4 90 28 0 27 0 9 28 52 38 19

1990 17 48 40 11 23 23 33 33 22 36 9 12 5 40 6 11 30 16 17 23 43 40 27

2010 8 24 32 8 18 9 10 23 14 26 6 4 3 26 4 6 23 7 10 12 32 30 27

1990 1 2 6 0 1 5 47 4 0 31 6 1 4 45 22 1 22 0 9 45 27 14 10

2010 0 1 6 0 0 2 13 2 0 39 3 0 2 48 18 0 13 0 6 18 29 18 10

Estimates of under-five, infant and neonatal mortality by Millennium Development Goal regionb,c
Developed regions Developing regions Northern Africa Sub-Saharan Africa Latin America & Caribbean Caucasus & Central Asia Eastern Asia Excluding China Southern Asia Excluding India South-eastern Asia Western Asia Oceania World 15 97 82 174 54 77 48 28 117 123 71 67 75 88 7 63 27 121 23 45 18 17 66 72 32 32 52 57 5 32 27 58 18 26 16 9 39 41 24 22 25 29 3.8 2.2 5.6 1.8 4.3 2.7 4.9 2.5 2.9 2.7 4.0 3.7 1.8 2.2 227 11,782 304 3,734 623 155 1,308 29 4,521 1,443 853 270 14 12,010 99 7,515 95 3,709 249 78 331 17 2,526 830 349 165 14 7,614 12 67 62 105 43 63 38 17 84 90 49 52 55 61 6 44 23 76 18 39 16 14 51 56 25 25 41 40 186 8,202 227 2,273 491 127 1,042 17 3,239 1,053 582 211 11 8,389 83 5,346 81 2,350 191 67 285 14 1,958 653 271 131 11 5,429 7 36 29 43 23 30 23 12 48 48 28 28 26 32 4 25 13 35 11 21 11 9 32 33 15 16 21 23 106 4,319 107 969 265 58 589 14 1,875 576 335 116 5 4,425 53 3,019 46 1,123 117 34 189 8 1,256 381 169 79 5 3,072

16

StatiStical table (ContInuED)

country, regional and global estimates of under-five, infant and neonatal mortality
Estimates of under-five, infant and neonatal mortality by uniCEF regionc
Under-five mortality rate (deaths per 1,000 live births) Millennium Average Development annual rate of Goal reduction target for (percent) 2015 1990–2010 53 58 52 65 26 29 40 18 18 1.8 1.8 2.3 1.6 3.2 2.9 2.9 4.1 4.3 Number of under-five deaths (thousands) Infant mortality rate (deaths per 1,000 live births) Number of infant deaths (thousands) Neonatal mortality rate Number of (deaths per 1,000 neonatal deaths live births) (thousands)

Region Africa Sub-Saharan Africa Eastern and Southern Africa West and Central Africa Middle East and North Africa Asia South Asia East Asia and Pacific Latin America and Caribbean Central and Eastern Europe/Commonwealth of Independent States Industrialized countries Developing countries Least developed countries World

1990 160 174 156 196 77 86 120 55 54

2010 111 121 98 143 41 48 67 24 23

1990 4,038 3,734 1,559 2,046 718 6,575 4,399 2,175 623

2010 3,804 3,709 1,322 2,241 415 3,186 2,492 694 249

1990 99 105 97 115 56 62 86 41 43

2010 71 76 63 88 31 37 52 19 18

1990 2,500 2,273 982 1,208 526 4,781 3,147 1,634 491

2010 2,431 2,350 858 1,398 316 2,496 1,929 567 191

1990 41 43 39 47 29 37 49 25 23

2010 33 35 30 39 18 24 33 13 11

1990 1,076 969 411 514 271 2,754 1,824 930 265

2010 1,169 1,123 425 647 180 1,602 1,239 363 117

50 10 97 170 88

23 6 63 110 57

17 3 32 57 29

3.9 2.6 2.2 2.2 2.2

371 118 11,784 3,497 12,010

136 65 7,516 2,949 7,614

41 9 67 106 61

19 5 44 71 40

303 97 8,204 2,200 8,389

114 55 5,346 1,912 5,429

21 5 36 47 32

11 3 25 34 23

149 61 4,320 1,024 4,425

65 36 3,019 956 3,072

Estimates of under-five, infant and neonatal mortality by World Health Organization regionc
Under-five mortality rate (deaths per 1,000 live births) Millennium Average Development annual rate of Goal reduction target for (percent) 2015 1990–2010 57 14 33 11 37 16 29 1.8 4.2 1.9 4.3 3.4 4.6 2.2 Number of under-five deaths (thousands) Infant mortality rate (deaths per 1,000 live births) Number of infant deaths (thousands) Neonatal mortality rate Number of (deaths per 1,000 neonatal deaths live births) (thousands)

Region Africa Americas Eastern Mediterranean Europe South-East Asia Western Pacific World

1990 172 42 100 33 111 48 88

2010 119 18 68 14 56 19 57

1990 3,606 670 1,392 431 4,299 1,607 12,010

2010 3,520 284 1,070 161 2,110 467 7,614

1990 104 34 74 27 78 37 61

2010 75 14 51 12 44 16 40

1990 2,200 530 1,031 353 3,013 1,257 8,389

2010 2,236 221 814 135 1,627 393 5,429

1990 42 18 38 14 45 22 32

2010 34 9 28 7 29 11 23

1990 933 289 533 181 1,780 709 4,425

2010 1,064 137 444 79 1,096 252 3,072

17

StatiStical table (ContInuED)

country, regional and global estimates of under-five, infant and neonatal mortality
Estimates of under-five, infant and neonatal mortality by World bank regionc
Under-five mortality rate (deaths per 1,000 live births) Millennium Average Development annual rate of Goal reduction target for (percent) 2015 1990–2010 55 28 38 16 32 19 16 18 25 40 58 4 29 2.1 2.4 2.5 4.5 2.2 4.2 3.8 4.3 4.0 2.9 1.8 3.5 2.2 Number of under-five deaths (thousands) Infant mortality rate (deaths per 1,000 live births) Number of infant deaths (thousands) Neonatal mortality rate Number of (deaths per 1,000 neonatal deaths live births) (thousands)

Region Low income Middle income Lower middle income Upper middle income Low and middle income East Asia & Pacific Europe & Central Asia Latin America & Caribbean Middle East & North Africa South Asia Sub-Saharan Africa High income World

1990 164 83 113 49 96 56 49 54 74 120 174 12 88

2010 107 51 69 20 62 24 23 23 33 67 121 6 57

1990 3,194 8,656 6,327 2,330 11,850 2,171 373 622 557 4,399 3,728 155 12,010

2010 2,667 4,860 4,163 698 7,527 691 136 249 255 2,492 3,704 85 7,614

1990 103 59 78 39 67 42 41 43 56 86 105 10 61

2010 70 38 50 16 44 20 19 18 27 52 76 5 40

1990 2,015 6,244 4,379 1,865 8,259 1,630 304 490 418 3,147 2,269 127 8,389

2010 1,731 3,623 3,036 588 5,355 565 114 191 210 1,929 2,346 72 5,429

1990 46 33 41 23 35 25 21 23 29 49 43 6 32

2010 33 23 29 11 25 13 11 11 16 33 35 4 23

1990 944 3,402 2,374 1,028 4,346 927 149 264 214 1,824 967 79 4,425

2010 866 2,161 1,787 374 3,027 362 65 117 123 1,239 1,121 45 3,072

Estimates of under-five, infant and neonatal mortality by united nations Population Division regionC
Under-five mortality rate (deaths per 1,000 live births) Millennium Average Development annual rate of Goal reduction target for (percent) 2015 1990–2010 5 32 57 27 37 58 53 28 6 18 4 12 29 3.8 2.2 2.2 2.6 2.3 1.8 1.8 3.0 4.7 4.3 2.3 1.7 2.2 Number of under-five deaths (thousands) Infant mortality rate (deaths per 1,000 live births) Number of infant deaths (thousands) Neonatal mortality rate Number of (deaths per 1,000 neonatal deaths live births) (thousands)

Region More developed regions Less developed regions Least developed countries Excluding least developed countries Excluding China Sub-Saharan Africa Africa Asia Europe Latin America & Caribbean Northern America Oceania World

1990 15 97 170 82 110 174 160 83 18 54 11 35 88

2010 7 63 110 49 70 121 111 46 7 23 7 25 57

1990 226 11,784 3,496 8,287 10,504 3,734 4,038 7,116 168 623 47 17 12,010

2010 99 7,516 2,949 4,567 7,201 3,709 3,804 3,453 59 249 35 16 7,614

1990 12 67 106 59 75 105 99 60 15 43 9 26 61

2010 6 44 71 37 49 76 71 36 6 18 6 19 40

1990 185 8,204 2,199 6,005 7,179 2,273 2,500 5,207 138 491 39 13 8,389

2010 83 5,346 1,912 3,435 5,075 2,350 2,431 2,716 49 191 30 12 5,429

1990 7 36 47 33 39 43 41 35 8 23 6 13 32

2010 4 25 34 22 27 35 33 23 4 11 4 10 23

1990 105 4,320 1,024 3,296 3,744 969 1,076 2,977 76 265 24 7 4,425

2010 53 3,019 956 2,063 2,838 1,123 1,169 1,729 31 117 20 6 3,072

— not available. Note: The data on population used to calculate the number of under-five and infant deaths and the data on live births used to calculate neonatal deaths are from World Population Prospects: The 2010 Revision, published by the United Nations Department of Economic and Social Affairs. a Data refer to Sudan as it was constituted in 2010, before South Sudan seceded on 9 July 2011. b See next page for country classifications by region. c The sum of the number of deaths by region may differ from the world total because of rounding.

18

Regional Classifications
The regional classifications that are referred to in the report and for which aggregate data are provided in the statistical table are Millennium Development Goal regions (see below). Aggregates presented for member organizations of the Inter-agency Group for Child Mortality Estimation may differ. Regions with the same names in different agencies may include different countries.

Developed regions
Albania, Andorra, Australia, Austria, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Canada, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Japan, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Monaco, Montenegro, Netherlands, New Zealand, Norway, Poland, Portugal, Republic of Moldova, Romania, Russian Federation, San Marino, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, The former Yugoslav Republic of Macedonia, Ukraine, United Kingdom, United States

Oceania

Cook Islands, Fiji, Kiribati, Marshall Islands, Micronesia (Federated States of), Nauru, Niue, Palau, Papua New Guinea, Samoa, Solomon Islands, Tonga, Tuvalu, Vanuatu
South-eastern Asia

Brunei Darussalam, Cambodia, Indonesia, Lao People’s Democratic Republic, Malaysia, Myanmar, Philippines, Singapore, Thailand, Timor-Leste, Viet Nam
Southern Asia

Developing regions
Caucasus and Central Asia

Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan
Eastern Asia

Afghanistan, Bangladesh, Bhutan, India, Iran (Islamic Republic of), Maldives, Nepal, Pakistan, Sri Lanka
Sub-Saharan Africa

China, Democratic People’s Republic of Korea, Mongolia, Republic of Korea
latin America and the Caribbean

Antigua and Barbuda, Argentina, Bahamas, Barbados, Belize, Bolivia (Plurinational State of), Brazil, Chile, Colombia, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, El Salvador, Grenada, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Suriname, Trinidad and Tobago, Uruguay, Venezuela (Bolivarian Republic of)
northern Africa

Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad, Comoros, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Djibouti, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mauritius, Mozambique, Namibia, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Seychelles, Sierra Leone, Somalia, South Africa, Sudan*, Swaziland, Togo, Uganda, United Republic of Tanzania, Zambia, Zimbabwe
Western Asia

Algeria, Egypt, Libyan Arab Jamahiriya, Morocco, Tunisia

Bahrain, Iraq, Jordan, Kuwait, Lebanon, Occupied Palestinian Territory, Oman, Qatar, Saudi Arabia, Syrian Arab Republic, Turkey, United Arab Emirates, Yemen

* Data refer to Sudan as it was constituted in 2010, before South Sudan seceded on 9 July 2011.

19

On the cover photo: A malnourished child waits for a meal of rice and dal at an anganwadi centre in Sullineabad Village, Bihar State, India. Anganwadis are part of the national Integrated Child Development Services programme, which provides basic health education, nutrition and related services at the village level for children and women in impoverished areas. Some 29 percent of children in the village suffer from severe acute malnutrition. Photo credits: cover, © UNICEF/NYHQ2009‑0908/Brian Sokol; page 2, © UNICEF/NYHQ2011‑1115/Kate Holt; page 4, © UNICEF/INDA2011‑00039/Graham Crouch; page 20, © UNICEF/INDA2010‑00212/Graham Crouch.

United Nations DESA/Population Division

The UN Inter-agency Group for Child Mortality Estimation
The Inter-agency Group for Child Mortality Estimation (IGME) was formed in 2004 to share data on child mortality, harmonize estimates within the UN system, improve methods for child mortality estimation, report on progress towards the Millennium Development Goals and enhance country capacity to produce timely and properly assessed estimates of child mortality. The IGME, led by the United Nations Children’s Fund and the World Health Organization, also includes the World Bank and the United Nations Population Division of the Department of Economic and Social Affairs as full members. The IGME’s independent Technical Advisory Group, comprising eminent scholars and independent experts in demography, provides technical guidance on estimation methods, technical issues and strategies for data analysis and data quality assessment. The IGME updates its child mortality estimates annually after reviewing newly available data and assessing data quality. This report contains the latest IGME estimates of child mortality at the country, regional and global levels. Country-specific estimates and the data used to derive them are available at www.childmortality.org.

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